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The author's response: I appreciate the comments by Drs Johnson and Fitzsimmons.1 In my opinion, three separate issues need to be emphasised when trying to understand the long-term time trends of gastric cancer, gastric ulcer and duodenal ulcer as evidenced by their mortality data in my recent article in Gut.2 First, the time trends depicted in the article are not a fluke of the birth-cohort analysis or solely related to the use of mortality data, but truly reflective of changes in the underlying epidemiology of these three diseases. The vital statistics serve as a means to accumulate large populations with gastric cancer or peptic ulcer from different countries and group such patients by their age …
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